A Clinton Adviser Weighs in on Society’s Stigma Against Those With Mental Illness

There’s been a lot of political movement lately toward improving services for Americans with mental illness. But does that mean the public’s stigma against mental illness is fading?

By Francie Diep

(Photo: Dan Kitwood/Getty Images)

Last week, Hillary Clinton unveiled a sweeping proposal that would expand suicide prevention efforts nationwide and get more Americans mental health care. Many mental-health advocates praisedthe plan, with the Bazelon Center for Mental Health Law’sJanice Frey-Angel calling it “the most comprehensive mental-health plan put forth by a presidential candidate.”Of course, whether Clinton will be able to pass her policies remains up in the air: In the past, Congress been reluctant to spend too much on mental-health fixes.

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Clinton’s proposed policies are just the latest in what’s been a flurry of legislation that seeks to assist the 44 million Americans suffering from mental-health problems, such as depression and addiction.In July, the Senate passed the Comprehensive Addiction and Recovery Act of 2016, which generally treats addiction as a mental-health problem, not a criminal justice one. The act is still awaiting approval for funding.

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But social acceptance for Americans will mental illnesses lags behind legal advances, according to a recent National Academies report. “We have data that compare the 1990s to the 2000s, and that showed no change in the desire for social distance,” says Bernice Pescosolido, a sociologist at Indiana University who studies stigma against people with mental illnesses in the United States. These mixed messages underscore the tough path to acceptance that mental-health issues continue to face—a barrier that can, at times, lead individuals not to seek treatment, for fear of inciting prejudice. To find out whether the future of mental health looks more promising, Pacific Standard talked with Pescosolido, who also acted as an adviser to the Clinton campaign’s health staffers working on her mental-health plan.

Are you satisfied with Clinton’s mental health plan?

I think it’s spectacular.

I think improving the quality of services and having services be evidence-based is a really important part of the plan.

I think focusing on the high school- and college-age populations is really important because we change society through a phenomenon called “cohort replacement,” rather than changing the hearts and minds of people my age. This is a more open generation. The research that we’ve done shows that they are more tolerant, in general.

You’ve mentioned before that the next horizon is acceptance and inclusion for people with mental illnesses. What are some strategies for getting there?

One of the things we can do is look to existing laws and make sure that they don’t discriminate. Laws and policies can be a vehicle to reduce prejudice and stigmatization.

Bernice Pescosolido. (Photo: Together Against Stigma)

I think we also can work on the local level to make the lives of people with mental-health problems easier, better. I remember a mom of a first-grader who was getting together a Cub Scout Den. All the typical boys were in the den, but that mom went out of her way to call the moms of the boys who weren’t typical and let them know that there was a Cub Scout Den forming.

Everybody can do something. It doesn’t have to be big things. You don’t have to be the advocate in your town.

I think if you’re working at the individual level, things aggregate up. I think if you’re working on policy, things trickle down. So when people say to me, “Well, what’s the way to reduce stigma?” We need everybody working at all levels. When you do that, you’ll see a shift in society.

Have things gotten better for folks with mental illness in the U.S.? Is there less stigma now?

Some things have changed and some things haven’t. In terms of the number of people who want to see people put in mental hospitals, that has decreased. If you talk about stigma in terms of the number of people who understand that it is a brain disorder, that there may be a genetic component, that’s happened.

But if you’re talking about inclusion and discrimination and prejudice, people still reject those with mental illness. They still fear them as being violent and unpredictable.

How about this idea that people who have a mental-health problem, or have had a mental-health problem in the past, have to be prohibited from having guns? We know that people who attempt suicide with guns are much more effective at taking their lives, so I think they’re afraid about that. But there’s also this undercurrent of prejudice about people with mental illness being violent, which all the research says is just not true, except for a very small group of people.

I think what that means for us is that some of the campaigns to reduce stigma in the past have worked, but they’ve taken us as far as they’re going to take us. This is a new era of stigma reduction. We have to focus more on issues of inclusion, acceptance, and understanding.

What’s an example of a marketing campaign that really worked to reduce stigma?

We borrowed, with permission, one of the public-service announcements (PSAs) that the Brits had done called “Schizo.” It was our most successfully rated video in terms of efficacy.

In particular, it changed the attitudes of people “outside the choir.” Those are people who report that they don’t know anybody with mental illness. We know one of the most potent predictors of stigma is whether or not you know somebody. If you know somebody, you’re less likely to stigmatize. There’s a lot of research on that, called the “contact hypothesis,” and it’s very potent.

But I have to say we also got complaints from people inside the choir — people with [schizophrenia], or families with, saying, “We think that reinforces the idea of people with mental illness being violent.” Here’s the deal. If you want to have a nice, boring PSA, it’s not going to get attention. It might make people with and families with feel better and that’s a laudable goal, but if you want to change the attitudes of the most stigmatizing people, then you have to get their attention.

You have to have a scientific base that helps you with the messages because things like PSAs cost a lot of money; if they aren’t effective, what’s the point?

Does it help when celebrities talk publicly about having mental illnesses?

I think it doesn’t hurt, but I’m not sure it helps because people look at somebody like Demi Lovato and they say: “I’m not Demi Lovato. I can’t do that.” [Editor’s Note: In 2011, Demi Lovato revealed publicly that she has bipolar disorder.]

One thing we’re seeing now that I’m very excited about is the number of young Hollywood [stars] coming out. So it’s not one isolated person like Lovato; it’s [also] Emma Stone and Amanda Seyfried, one after another. It’s just great.

Addiction treatment routinely fails people with mental illnesses, while mental health care often ignores addiction. And everywhere, stigma is rife. Can a tragic death prompt a more intelligent approach?